Repeat 2-week wait referrals for colorectal cancer.

Area of Science:

• Gastroenterology
• Oncology
• Health Services Research

Background:

• The '2-week wait' pathway for suspected colorectal cancer (CRC2ww) is crucial for timely diagnosis.
• Inappropriate use of this pathway may lead to clinic overload and delayed care for other patients.
• Patients previously investigated for colorectal cancer may represent a group not requiring repeat urgent referral.

Purpose of the Study:

• To determine the incidence of repeat referrals within the CRC2ww pathway.
• To assess the diagnostic yield of these repeat referrals.
• To evaluate the impact of repeat referrals on healthcare resource utilization.

Main Methods:

• Retrospective analysis of all CRC2ww referrals over a 4-year period.
• Data extraction from multidisciplinary team, endoscopy, and imaging databases.
• Identification of referral indications, outcomes, and repeat referral instances.

Main Results:

• A total of 2735 CRC2ww referrals were analyzed, with 122 (4.3%) being repeat referrals.
• The incidence of repeat referrals increased from 2% to 6% between 2008 and 2010.
• The diagnostic yield for cancer was lower in repeat referrals (5%) compared to initial referrals (10%), though not statistically significant (P=0.07).

Conclusions:

• Repeat CRC2ww referrals occur at a low but increasing incidence.
• While the diagnostic yield is lower, it remains significant enough to warrant careful consideration.
• Excluding patients with previous investigations from urgent assessment may not substantially decrease workload and could potentially delay cancer diagnosis.